Provider Demographics
NPI:1083215032
Name:LONG, SHEREE D (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHEREE
Middle Name:D
Last Name:LONG
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 HIGH RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-1283
Mailing Address - Country:US
Mailing Address - Phone:757-620-3286
Mailing Address - Fax:
Practice Address - Street 1:503 HIGH RIDGE CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-1283
Practice Address - Country:US
Practice Address - Phone:757-620-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001191225163W00000X
VAL-118465163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse